Permit • • --CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00592
`T f CARD • 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9402 SW WASHINGTON SQUARE RD P01
Project: Dick's Sporting Goods Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (2) branch circuits for TI
Contractor: NIXON ELECTRIC CORP Owner: PPR WASHINGTON SQUARE LLC
PO BOX 68569 PO BOX 847
PORTLAND, OR 97268 CARLSBAD, CA 92018
PHONE: 503 - 654 -8841 PHONE:
FAX: 503 - 345 -3403
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/15/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/15/2012 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp: •
•
•
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations' contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 9 - 001 -0090. i��i�C.l 1. J �'L
You may obtain na a/ /c opy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ' /
Issued By: I.1Z Permittee Signature: ppit) tt k/0-n V.
JJ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
• OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
•
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
10/12/2012 01:39 5033453403 NIXON ELECTRIC #1527 P.002/002
Electrical Permit Applica ' FOR OFFICE LSE ONLY
City of Tigard C EIVED Received
Resery / Permit
Illi g Receiv �Q j,7 1 1L 6 1 � , BS4Y
--- • 13125 SW Hall Blvd., Tigard, • O Plan Review Q
Phone: 503.718.2439 Fax: 503.59 ro Datei ; Other Permtt a(:�p!t.�0 /A- 0 0 / cre
Inspection Li ne: 5 03.639.4175 ®`�� 1 LU It
T 1(3,k K ll p Date Ready/By: 1 uis to See Page 2 for
Internet: www.tigard- or.gov Notified/Method: fl G Supplemental Information
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❑ New construction ®AdditiortWieR I :i...'et,;-4.:Pri Please check all that apply (submit 2 sets of plans vac= checked below):
❑ Service or feeder 400 amps or more ['Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
- il :;p ; i,14, 1114111' :;� _ r s �;v , .s - : y f,,,�, ;;�,w. 4 A_fi•• - : i: Ai exceeds 10,000 amps at 150 volts or ❑ Floatin _
irr_. i_y � ?.:p lr.:.r7:" ,1 f. :4,:c m r. x.. 6'"I . :C.`.�L 6 Y , . C! c ^', a . ,.. 1 '.iia+4;i7,,;; iii413 1i : : i .=1, g buildings_
± - % •'. - , var_. ._.,.n,.. ..,. ^1.!. ern :1
.� ��:- ;.,..�;. L.••�_.. :- . : : : :n... :__._. ,_.a. - - ,�, ..-:a_ ,.. f.:.:., -_ : -! ..' ,,.:....r, :,:_._. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
,:rx- Emergency system. larger separately derived system.
.. y.�.,,:�: � •!.� _ -�:- r ge cY Y SR P Y �
1i� _- = : ��� >C :ti!i - E ^� - - � ��' VN'iyi;. rv.E:� i! :!i:.� � s� :r_ - y
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a- _. _... - _..,, _.. %�.:• ... ^._ .... -c� ..,: ,. , .. ^ „t - �d!'E ❑Addition of new motor load of El "A• , •E” `I.2" ••1_3"
Job no.: I Job site address: 9402 SW Washington Square loos>P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Dicks I Project name: Dicks SPorting Goods ❑ Service or feeder 600 amps or more. T
ii :; : :$:+Li�•._.c -a . ............ ,• c - ..;_; :.n x--:7
�: ,•!. ,ter �. . ^w�,. t ,r..a_.1 r ^r ,^.' ea
? r: r:;;.} c_.._ �, 1a: ii;r. :t ::?!!??;= i �.....,..'••- � . � r......w._ ` �j�E' ::• �.s;: � .: ^ 1 .:wr.� -•..:__
Cross street/directions to job site: Descripti 1' Q ty. I Fee. • l Total 1 -
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1 ,000 sq. R or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 I
Tax map/parcel no.:
Wag: xrn .�.__, :. : : :c :•�•x.;,; :,, :: :.;cam :, c. c• r. :x7, : :•; : : : : :r : :-' : : :�;ii5'1' _i :i� :i:E -:! (with u � 75.00 2
.,.c -_._��_ ..�: i::: i :_='. ., ■M1M1�7��{p,'.. :�: �!. _ =t.l :r '-i {-.:6?r._ka'! :!Eiir �:ia_^ji.ry :I :N.
....^. ;.YY :.af•�c:...,•c.:- :.�• -....1 ......... ,....,.�f...: R'.!! abO energy, residential
II)
Limited energy, multi - family 75.00 2
Small renovation residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 ' 2
_ �� �" :' ^:�JE a _::. #s 201 to 400 am
.c _ .gyp __ P Ia Oli i '" fim :,.:i r. ^c
4 �_ !. r ,r :.� `i„ :�•1,n �._.`�.` '= �i!';l : :x : :.
!, e:r ■=� amps amps 133.56 2
p
401 amps to 600 amps 200.34 2
Name: 601 snips to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/o
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
_ ....__ _i::: " .au �,: - -_.._. •_•,. ^..4•i : - !' - ELY:•' f',�, M:r rw.l..�1'�I.! .�! .-
t -y .Oti' , ' �e ; w '• 3' rf _ _
-*aril:: i above service or feeder fee,
7 " -r�? = ra,�'^ `"'S' ,�seilc;S y iz :...F(? „' =ES, each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56 18 56.18 2
Contact name: branch circuit
Each add'l branch circuit 1 7.42 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84
_
::r.: - :r-�Tr':n7rG"•ig .:. .er . ,.t n�ii ?F ia`. .. ,jr�j.._r-'-• :.
..;1� ;,!;,-��?•a.-'�,' -.:1' . :.�;�;� �r�!%�,. - � + :_- .n'.1, ^! :�: �•�-''FiiiirR.(77 � , : :i :fr_�;.__ :• §� •.,'ri¢il� ^ :�' +"i3'e : :�. Signal CIICUn(S) Or limited-energy
Business name: Nixon Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: PO Box 68569 Additional inspection (1 hr min) 6625/ hr
City/State/ZIP: Portland, OR 97268 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 654 - 8841 Fax: (503) 345 - 3403 Inspections for which no fee is
s ecificall listed S hr min 90.00/ hr
�' ,a: :arc•.. --
CCB Lic.: 191508 / �I/ Electrical Lic • C655 Suprv. Lie.: 3185 -5 • •'` --i.• t' ' °• nli t • �. =ikt: �r,d_ic ±�lYt _•xe ''•: - -r ca.._a::cc, 7: ;.:
Subtotal:
- Suprv. Electrician signature, required Plan review (25% of permit fee):
..**** /4er,.....g.:or.dops.t. Print name: Craig Robison Date: 10/12/2012 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 71.23
Authorized signature:
This permit application expires Ka permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:1 BuildingiPennita \ELC- PermitApp.doc 07/01/10 440- 4615T(11/05/COM/WEB
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